EP2195073B1 - Wirkstoffdepots mit einem oder mehreren verankerungselementen - Google Patents

Wirkstoffdepots mit einem oder mehreren verankerungselementen Download PDF

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Publication number
EP2195073B1
EP2195073B1 EP09800802.2A EP09800802A EP2195073B1 EP 2195073 B1 EP2195073 B1 EP 2195073B1 EP 09800802 A EP09800802 A EP 09800802A EP 2195073 B1 EP2195073 B1 EP 2195073B1
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EP
European Patent Office
Prior art keywords
suture
drug depot
depot
drug
biodegradable
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Not-in-force
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EP09800802.2A
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English (en)
French (fr)
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EP2195073A2 (de
EP2195073A4 (de
Inventor
William F. Mckay
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Warsaw Orthopedic Inc
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Warsaw Orthopedic Inc
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Publication of EP2195073A2 publication Critical patent/EP2195073A2/de
Publication of EP2195073A4 publication Critical patent/EP2195073A4/de
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Publication of EP2195073B1 publication Critical patent/EP2195073B1/de
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A61K9/0024—Solid, semi-solid or solidifying implants, which are implanted or injected in body tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
    • A61K47/10—Alcohols; Phenols; Salts thereof, e.g. glycerol; Polyethylene glycols [PEG]; Poloxamers; PEG/POE alkyl ethers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
    • A61K47/34—Macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyesters, polyamino acids, polysiloxanes, polyphosphazines, copolymers of polyalkylene glycol or poloxamers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00893—Material properties pharmaceutically effective
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0404—Buttons

Definitions

  • Drugs may be delivered to patients by a variety of methods including oral, intravenous, intramuscular, inhalation, topical, subcutaneous delivery or delivery directly or locally to the treatment site ( e.g ., intrathecally, intraspinally, intraarticularly, etc. ).
  • the method of delivery chosen depends, among other things, upon the condition being treated, desired therapeutic concentration of the drug to be achieved in the patient and the duration of drug concentration that must be maintained.
  • drug depots which allow a drug to be introduced or administered to sites beneath the skin of a patient so that the drug is slowly released over a long period of time.
  • Such drug depots allow the drug to be released from the depot in a relatively uniform dose over weeks, months or even years. This method of administering drugs is becoming especially important for contraceptives and cancer drugs that are implanted subcutaneously.
  • the drug depot may migrate from the implant site prior to surgical closure (e.g., floats off in blood or shifts as tissues are repositioned during surgical site closure) or as physiological conditions change (e.g ., repair and regeneration of cells, tissue ingrowth, movement at implant site, etc. ). At times, this may reduce efficacy of the drug as the drug depot migrates away from the implant site and lodges in a distant site. If this occurs, the drug depot will have to be removed from the distant site and have to be reinserted causing additional physical and psychological trauma to a patient. In some cases, if the drug depot migrates into a joint, the drug depot may inhibit movement. In more severe cases, if the drug depot migrates, it may restrict blood flow causing an ischemic event (e.g ., embolism, necrosis, infarction, etc. ), which could be detrimental to the patient.
  • an ischemic event e.g ., embolism, necrosis, infarction, etc.
  • Postoperative pain tends to be a difficult condition to treat and may be detrimental to the patient if not properly treated.
  • the site of the surgery has a profound effect upon the degree of postoperative pain a patient may suffer.
  • operations on the thorax and upper abdomen are more painful than operations on the lower abdomen, which in turn are more painful than peripheral operations on the limbs.
  • any operation involving a body cavity, large joint surfaces, the spine or deep tissues should be regarded as painful.
  • operations on the thorax or upper abdomen may produce widespread changes in pulmonary function, an increase in abdominal muscle tone and an associated decrease in diaphragmatic function. The result will be an inability to cough and clear secretions, which may lead to lung collapse and pneumonia.
  • Prolonged pain can reduce physical activity and lead to venous stasis and an increased risk of deep vein thrombosis and consequently pulmonary embolism.
  • These problems are unpleasant for the patient and may prolong hospital stay and are exacerbated if after implantation the drug depot migrates away from the implant site.
  • New drug depot compositions and methods are needed, which can easily allow accurate and precise placement of a drug depot. When implanting several drug depots at a time, drug depot compositions and methods are needed that accurately and precisely allow placement of the drug depot in a manner that optimizes location, accurate spacing, and drug distribution. New drug depot compositions and methods are also needed to effectively treat post-operative pain.
  • a new implantable drug depot that improves drug efficacy and reduces unwanted migration of the drug depot.
  • new drug depot compositions and methods are provided that effectively prevent, treat or reduce postoperative pain and/or inflammation by providing consistent analgesic and/or anti-inflammatory efficacy at the target tissue site of pain generation.
  • the drug depot is pre-attached to a needle and suture and includes a tie-off system, which easily allows the surgeon to suture the depot to the target tissue site of pain generation.
  • a drug depot is provided that is pre-knotted and pre-threaded so that all the surgeon has to do is pass the needle through the soft tissue and pull the needle and suture back through the drug depot.
  • the knot will lock the depot in place and all the surgeon needs to do is cut the suture.
  • a drug depot implantable at or near a target tissue site beneath the skin of a patient comprising a therapeutically effective amount of a drug and at least one surface adapted to receive one or more anchoring members so as to limit movement of the drug depot at or near the target tissue site, wherein at least one region of the drug depot is capable of releasing the therapeutically effective amount of the drug over a period of at least one day.
  • the at least one surface of the drug depot comprises one or more channels, holes, grooves, slits, loops, hooks, barbs, posts and/or clips adapted to receive the one or more anchoring members.
  • the drug depot comprises one or more sutures, yarns, threads, lines, and/or staples used as the anchoring members.
  • a drug depot implantable at or near a target tissue site beneath the skin of a patient comprising a therapeutically effective amount of a drug and one or more channels adapted to receive one or more sutures so as to limit movement of the drug depot at or near the target tissue site, wherein the drug depot is capable of releasing the therapeutically effective amount of the drug over a period of at least one day.
  • a drug depot implantable at or near a target tissue site beneath the skin of a patient comprising a therapeutically effective amount of a drug and one or more channels adapted to receive one or more sutures, the one or more sutures comprising at least two regions, each region having a surface larger than the one or more channels so that when the suture is passed through the one or more channels movement of the drug depot is limited at or near the target tissue site, wherein the drug depot is capable of releasing the therapeutically effective amount of the drug over a period of at least one day.
  • a drug depot implantable at or near a target tissue site beneath the skin of a patient comprising a therapeutically effective amount of a drug and one or more channels adapted to receive one or more sutures, the one or more sutures comprising at least two knotted, rimmed, beaded, ridged, or clipped areas spaced apart from each other, each knotted, rimmed, beaded, ridged, or clipped area having a surface larger than the one or more channels so that when the suture is passed through the one or more channels the depot is locked in place and movement of the drug depot is limited at or near the target tissue site, wherein the drug depot is capable of releasing the therapeutically effective amount of the drug over a period of at least one day.
  • a method of treating or preventing postoperative pain or inflammation in a patient in need of such treatment comprising suturing one or more biodegradable drug depots comprising a therapeutically effective amount of an analgesic and/or anti-inflammatory agent or pharmaceutically acceptable salt thereof at or near a target tissue site beneath the skin, wherein the drug depot comprises at least one surface adapted to receive one or more sutures so as to limit movement of the drug depot at or near the target tissue site and the drug depot is capable of releasing the analgesic and/or anti-inflammatory agent or pharmaceutically acceptable salt thereof over a period of at least one day.
  • a drug depot includes one, two, three or more drug depots.
  • analgesic refers to an agent or compound that can reduce, relieve or eliminate pain.
  • analgesic agents include but are not limited to acetaminophen, a local anesthetic, such as for example, lidocaine, bupivicaine, ropivacaine, opioid analgesics such as buprenorphine, butorphanol, dextromoramide, dezocine, dextropropoxyphene, diamorphine, fentanyl, alfentanil, sufentanil, hydrocodone, hydromorphone, ketobemidone, levomethadyl, levorphanol, mepiridine, methadone, morphine, nalbuphine, opium, oxycodone, papaveretum, pentazocine, pethidine, phenoperidine, piritramide, dextropropoxyphene, remifentanil, sufentanil, tilidine, tramadol,
  • anti-inflammatory agent refers to an agent or compound that has anti-inflammatory effects. These agents may remedy pain by reducing inflammation.
  • anti-inflammatory agents include, but are not limited to, a statin, sulindac, sulfasalazine, naroxyn, diclofenac, indomethacin, ibuprofen, flurbiprofen, ketoprofen, aclofenac, aloxiprin, aproxen, aspirin, diflunisal, fenoprofen, mefenamic acid, naproxen, phenylbutazone, piroxicam, meloxicam, salicylamide, salicylic acid, desoxysulindac, tenoxicam, ketoralac, clonidine, flufenisal, salsalate, triethanolamine salicylate, aminopyrine, antipyrine, oxyphenbutazone, apazone, cintazone, flufenamic acid, clonixer
  • Anti-inflammatory agents also include other compounds such as steroids, such as for example, fluocinolone, cortisol, cortisone, hydrocortisone, fludrocortisone, prednisone, prednisolone, methylprednisolone, triamcinolone, betamethasone, dexamethasone, beclomethasone, fluticasone interleukin-1 receptor antagonists, thalidomide (a TNF- ⁇ release inhibitor), thalidomide analogues (which reduce TNF- ⁇ production by macrophages), bone morphogenetic protein (BMP) type 2 or BMP-4 (inhibitors of caspase 8, a TNF- ⁇ activator), quinapril (an inhibitor of angiotensin II, which upregulates TNF- ⁇ ), interferons such as IL-11 (which modulate TNF- ⁇ receptor expression), and aurin-tricarboxylic acid (which inhibits TNF- ⁇ ), guanidinoethyld
  • anti-inflammatory agents include, for example, naproxen; diclofenac; celecoxib; sulindac; diflunisal; piroxicam; indomethacin; etodolac; meloxicam; ibuprofen; ketoprofen; r-flurbiprofen; mefenamic; nabumetone; tolmetin, and sodium salts of each of the foregoing; ketorolac bromethamine; ketorolac tromethamine; ketorolac acid; choline magnesium trisalicylate; rofecoxib; valdecoxib; lumiracoxib; etoricoxib; aspirin; salicylic acid and its sodium salt; salicylate esters of alpha, beta, gamma-tocopherols and tocotrienols (and all their d, 1, and racemic isomers); methyl, ethyl, propyl, isopropyl, n-buty
  • steroids include, for example, 21-acetoxypregnenolone, alclometasone, algestone, amcinonide, beclomethasone, betamethasone, budesonide, chloroprednisone, clobetasol, clobetasone, clocortolone, cloprednol, corticosterone, cortisone, cortivazol, deflazacort, desonide, desoximetasone, dexamethasone, dexamethasone 21-acetate, dexamethasone 21-phosphate di-Na salt, diflorasone, diflucortolone, difluprednate, enoxolone, fluazacort, flucloronide, flumethasone, flunisolide, fluocinolone acetonide, fluocinonide, fluocortin butyl, fluocortolone, fluorometholone, fluperolone a
  • statin examples include, but is not limited to, atorvastatin, simvastatin, pravastatin, cerivastatin, mevastatin (see U.S. Pat. No. 3,883,140 , the entire disclosure is herein incorporated by reference), velostatin (also called synvinolin; see U.S. Pat. Nos. 4,448,784 and 4,450,171 these entire disclosures are herein incorporated by reference), fluvastatin, lovastatin, rosuvastatin and fluindostatin (Sandoz XU-62-320), dalvastain ( EP Appln. Publn. No.
  • the statin may comprise mixtures of (+)R and (-)-S enantiomers of the statin.
  • the statin may comprise a 1:1 racemic mixture of the statin.
  • Anti-inflammatory agents also include those with anti-inflammatory properties, such as, for example, amitriptyline, carbamazepine, gabapentin, pregabalin, clonidine, or a combination thereof.
  • a drug e.g., an anti-inflammatory agent, analgesic, and the like
  • the inventor(s) are also referring to a pharmaceutically acceptable salt of the drug including stereoisomers.
  • Pharmaceutically acceptable salts include those salt-forming acids and bases that do not substantially increase the toxicity of the compound.
  • salts of alkali metals such as magnesium, calcium, sodium, potassium and ammonium
  • salts of mineral acids such as hydrochloric, hydriodic, hydrobromic, phosphoric, metaphosphoric, nitric and sulfuric acids
  • salts of organic acids such as tartaric, acetic, citric, malic, benzoic, glycollic, gluconic, gulonic, succinic, arylsulfonic, e.g., p-toluenesulfonic acids, or the like.
  • Treating" or treatment of a disease or condition refers to executing a protocol, which may include administering one or more drugs to a patient (human, normal or otherwise, or other mammal), in an effort to alleviate signs or symptoms of the disease. Alleviation can occur prior to signs or symptoms of the disease or condition appearing, as well as after their appearance. Thus, “treating” or “treatment” includes “preventing” or “prevention” of disease or undesirable condition. In addition, “treating” or “treatment” does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes protocols that have only a marginal effect on the patient. "Reducing pain” includes a decrease in pain and does not require complete alleviation of pain signs or symptoms, and does not require a cure.
  • reducing pain includes even a marginal decrease in pain.
  • the administration of the effective dosages of at least one analgesic agent and at least one anti-inflammatory agent may be used to prevent, treat or relieve the symptoms of pain and/or inflammation.
  • “Localized” delivery includes delivery where one or more drugs are deposited within a tissue, for example, a nerve root of the nervous system or a region of the brain, or in close proximity (within about 10 cm, or preferably within about 5 cm, for example) thereto.
  • a “targeted delivery system” provides delivery of one or more drugs depots having a quantity of therapeutic agent that can be deposited at or near the target site as needed for treatment of pain, inflammation or other disease or condition.
  • mammal refers to organisms from the taxonomy class "mammalian,” including but not limited to humans, other primates such as chimpanzees, apes, orangutans and monkeys, rats, mice, cats, dogs, cows, horses, etc. In various embodiments, the mammal is a human patient.
  • a drug depot implantable at or near a target tissue site beneath the skin of a patient comprising a therapeutically effective amount of a drug and at least one surface adapted to receive one or more anchoring members so as to limit movement of the drug depot at or near the target tissue site, wherein at least one region of the drug depot is capable of releasing the therapeutically effective amount of the drug over a period of at least one day.
  • a “drug depot” comprises the composition in which at least one active pharmaceutical ingredient or drug is administered to the body.
  • a drug depot may comprise a physical structure to facilitate implantation and retention in a desired site (e.g ., a disc space, a spinal canal, a tissue of the patient, particularly at or near a site of surgery, pain, or site of inflammation, etc. ).
  • the drug depot also comprises the drug itself.
  • drug as used herein is generally meant to refer to any substance that alters the physiology of a patient.
  • drug may be used interchangeably herein with the terms “therapeutic agent,” “therapeutically effective amount,” and “active pharmaceutical ingredient” or “API.” It will be understood that unless otherwise specified a “drug” formulation may include more than one therapeutic agent, wherein exemplary combinations of therapeutic agents include a combination of two or more drugs.
  • the drug provides a concentration gradient of the therapeutic agent for delivery to the site.
  • the drug depot provides an optimal drug concentration gradient of the therapeutic agent at a distance of up to about 0.1 cm to about 5 cm from the implant site, and comprises at least one anti-inflammatory agent or its pharmaceutically acceptable salt and/or at least one analgesic agent or its pharmaceutically acceptable salt.
  • a “depot” includes but is not limited to capsules, coatings, matrices, wafers, sheets, strips, ribbons, pills, pellets, or other pharmaceutical delivery or a combination thereof.
  • Suitable materials for the depot are ideally pharmaceutically acceptable biodegradable and/or any bioabsorbable materials that are preferably FDA approved or GRAS materials. These materials can be polymeric or non-polymeric, as well as synthetic or naturally occurring, or a combination thereof.
  • the depot will be a solid or semi-solid formulation comprised of a biocompatible material that can be biodegradable.
  • solid is intended to mean a rigid material, while “semi-solid” is intended to mean a material that has some degree of flexibility, thereby allowing the depot to bend and conform to the surrounding tissue requirements.
  • a “therapeutically effective amount” or “effective amount” is such that when administered, the drug results in alteration of the biological activity, such as, for example, inhibition of inflammation, reduction or alleviation of pain, improvement in the condition through muscle relaxation, etc.
  • the dosage administered to a patient can unless otherwise specified or apparent from context be as single or multiple doses depending upon a variety of factors, including the drug's administered pharmacokinetic properties, the route of administration, patient conditions and characteristics (sex, age, body weight, health, size, etc. ), extent of symptoms, concurrent treatments, frequency of treatment and the effect desired.
  • the formulation is designed for immediate release.
  • the formulation is designed for sustained release.
  • the formulation comprises one or more immediate release surfaces and one or more sustain release surfaces.
  • sustained release or “sustain release” (also referred to as extended release or controlled release) are used herein to refer to one or more therapeutic agent(s) that is introduced into the body of a human or other mammal and continuously or continually releases a stream of one or more therapeutic agents over a predetermined time period and at a therapeutic level sufficient to achieve a desired therapeutic effect throughout the predetermined time period.
  • Reference to a continuous or continual release stream is intended to encompass release that occurs as the result of biodegradation in vivo of the drug depot, or a matrix or component thereof, or as the result of metabolic transformation or dissolution of the therapeutic agent(s) or conjugates of therapeutic agent(s).
  • sustained release formulations may, by way of example, be created as films, slabs, pellets, microparticles, microspheres, microcapsules, spheroids, shaped derivatives and paste. Further, the formulations may be used in conjunction with any implantable, or insertable system that a person of ordinary skill would appreciate as useful in connection with embodiments herein including but not limited to parenteral formulations, microcapsules, pastes, implantable rods, pellets, plates or fibers, etc.
  • immediate release is used herein to refer to one or more therapeutic agent(s) that is introduced into the body and that is allowed to dissolve in or become absorbed at the location to which it is administered, with no intention of delaying or prolonging the dissolution or absorption of the drug.
  • Immediate release refers to the release of drug within a short time period following administration, e.g ., generally within a few minutes to about 1 to 2 hours.
  • release rate profile refers to the percentage of active ingredient that is released over fixed units of time, e.g ., mcg/hr, mcg/day, mg/hr, mg/day, 10% per day for ten days, and the like.
  • a release rate profile may be but need not be linear.
  • the drug depot may be a pellet that releases at least one analgesic agent in a bolus dose and at least one anti-inflammatory agent over a period of time.
  • biodegradable includes that all or parts of the drug depot will degrade over time by the action of enzymes, by hydrolytic action and/or by other similar mechanisms in the human body.
  • biodegradable includes that the depot can break down or degrade within the body to non-toxic components after or while a therapeutic agent has been or is being released.
  • bioerodible it is meant that the depot will erode or degrade over time due, at least in part, to contact with substances found in the surrounding tissue, fluids or by cellular action.
  • bioabsorbable it is meant that the depot will be broken down and absorbed within the human body, for example, by a cell or tissue.
  • Biocompatible means that the depot will not cause substantial tissue irritation or necrosis at the target tissue site.
  • the depot and/or anchoring members may comprise non-biodegradable material.
  • non-biodegradable polymers include, but are not limited to, various cellulose derivatives (carboxymethyl cellulose, cellulose acetate, cellulose acetate propionate, ethyl cellulose, hydroxypropyl methyl cellulose, hydroxyalkyl methyl celluloses, and alkyl celluloses), silicon and silicon-based polymers (such as polydimethylsiloxane), polyethylene-co-(vinyl acetate), poloxamer, polyvinylpyrrolidone, poloxamine, polypropylene, polyamide, polyacetal, polyester, poly ethylene-chlorotrifluoroethylene, polytetrafluoroethylene (PTFE or "TeflonTM”), styrene butadiene rubber, polyethylene, polypropylene, polyphenylene oxide-polystyrene, poly- ⁇ -chloro-p-xylene, polymethylpentene
  • Non-resorbable polymers can also include, but are not limited to, delrin, polyurethane, copolymers of silicone and polyurethane, polyolefins (such as polyisobutylene and polyisoprene), acrylamides (such as polyacrylic acid and poly(acrylonitrile-acrylic acid)), neoprene, nitrile, acrylates (such as polyacrylates, poly(2-hydroxy ethyl methacrylate), methyl methacrylate, 2-hydroxyethyl methacrylate, and copolymers of acrylates with N-vinyl pyrrolidone), N-vinyl lactams, polyacrylonitrile, glucomannan gel, vulcanized rubber and combinations thereof.
  • delrin polyurethane, copolymers of silicone and polyurethane
  • polyolefins such as polyisobutylene and polyisoprene
  • acrylamides such as polyacrylic acid and poly
  • polyurethanes examples include thermoplastic polyurethanes, aliphatic polyurethanes, segmented polyurethanes, hydrophilic polyurethanes, polyether-urethane, polycarbonate-urethane and silicone polyether-urethane.
  • suitable non-resorbable material include, but are not limited to, lightly or highly cross-linked biocompatible homopolymers and copolymers of hydrophilic monomers such as 2-hydroxyalkyl acrylates and methacrylates, N-vinyl monomers, and ethylenically unsaturated acids and bases; polycyanoacrylate, polyethylene oxide-polypropylene glycol block copolymers, polygalacturonic acid, polyvinyl pyrrolidone, polyvinyl acetate, polyalkylene glycols, polyethylene oxide, collagen, sulfonated polymers, vinyl ether monomers or polymers, alginate, polyvinyl amines, polyvinyl pyridine, and polyvinyl imidazole.
  • hydrophilic monomers such as 2-hydroxyalkyl acrylates and methacrylates, N-vinyl monomers, and ethylenically unsaturated acids and bases
  • polycyanoacrylate polyethylene oxide-polypropylene glycol block copo
  • the degradation time of the polymer can be reduced, thus making the polymer, for the purpose of this invention, appear to be non-resorbable over the time frame of the use of the material for this invention.
  • pain management medication includes one or more therapeutic agents that are administered to prevent, alleviate or remove pain entirely. These include anti-inflammatory agents, muscle relaxants, analgesics, anesthetics, narcotics, and so forth, and combinations thereof.
  • the depot can be designed to cause an initial burst dose of one or more therapeutic agents within the first 24 hours after implantation.
  • "Initial burst” or “burst effect” or “bolus dose” or “pulse dose” refer to the release of therapeutic agent from the depot during the first 24 hours after the depot comes in contact with an aqueous fluid (e.g ., synovial fluid, cerebral spinal fluid, etc. ).
  • the burst effect may be an immediate release.
  • the "burst effect” is believed to be due to the increased release of therapeutic agent from the depot.
  • the initial burst effect or bolus dose may be determined beforehand by formulating the depot by calculating the quotient obtained by dividing (i) the effective amount by weight of therapeutic agent to be released from the depot or region in a predetermined initial period of time after implantation of the depot, by (ii) the total amount of therapeutic agent that is to be delivered from an implanted composition. It is understood that the initial burst may vary depending on the shape and surface area of the implant.
  • the burst effect with respect to the region or depot in various embodiments, can be designed so that a larger initial dose may be released over a short period of time to achieve the desired effect. For example, if a drug depot is designed to release 15mg of morphine per 48 hours, then the initial burst dose or bolus dose region or depot will be designed to release a percentage of the dose within the first 24 hours (e.g., 10mg of morphine or 66% of the 48 hour dose within 24 hours). Thus, the burst effect of the drug depot or region releases more therapeutic agent than the sustained release region or depot.
  • a region or depot that utilizes a burst effect or bolus dose will release more therapeutic agent (e.g., analgesic and/or anti-inflammatory) than the sustained release region or depot.
  • therapeutic agent e.g., analgesic and/or anti-inflammatory
  • the initial burst effect of the drug depot or region of the drug depot will be advantageous as it will provide more immediate pain and/or inflammation relief as a bolus dose of drug will be released at or near the target tissue site and provide the desired reducing
  • the drug depot or region of the drug depot may release 51%, 52%, 53%, 54%, 55%, % 56%, 57%, 58%, 59%, 60%, 61%, 62%, 63%, 64%, 65%, 66%, 67%, 68%, 69%, 70%, 71%, 72%, 73%, 74%, 75%, 76%, 77%, 78%, 79%, 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% of the daily dose within the first one to twelve hours to reduce, prevent or treat pain and/or inflammation.
  • the pain and/or inflammation may also be postoperative pain following surgery.
  • the drug depot can comprise at least one analgesic agent or its pharmaceutically acceptable salt and/or at least one anti-inflammatory agent or its pharmaceutically acceptable salt may be co-administered with a muscle relaxant. Co-administration may involve administering at the same time in separate drug depots or formulating together in the same drug depot.
  • Exemplary muscle relaxants include by way of example and not limitation, alcuronium chloride, atracurium bescylate, baclofen, carbolonium, carisoprodol, chlorphenesin carbamate, chlorzoxazone, cyclobenzaprine, dantrolene, decamethonium bromide, camdinium, gallamine triethiodide, hexafluorenium, meladrazine, mephensin, metaxalone, methocarbamol, metocurine iodide, pancuronium, pridinol mesylate, styramate, suxamethonium, suxethonium, thiocolchicoside, tizanidine, tolperisone, tubocuarine, vecuronium, or combinations thereof.
  • the drug depot may also comprise other therapeutic agents or active ingredients in addition to the at least one analgesic agent or its pharmaceutically acceptable salt and at least one anti-inflammatory agent or its pharmaceutically acceptable salt.
  • additional therapeutic agents include, but are not limited to, integrin antagonists, alpha-4 beta-7 integrin antagonists, cell adhesion inhibitors, interferon gamma antagonists, CTLA4-Ig agonists/antagonists (BMS-188667), CD40 ligand antagonists, Humanized anti-IL-6 mAb (MRA, Tocilizumab, Chugai), HMGB-1 mAb (Critical Therapeutics Inc.), anti-IL2R antibodies (daclizumab, basilicimab), ABX (anti IL-8 antibodies), recombinant human IL-10, or HuMax IL-15 (anti-IL 15 antibodies).
  • IL-1 inhibitors such as Kineret® (anakinra) which is a recombinant, non-glycosylated form of the human inerleukin-1 receptor antagonist (IL-1Ra), or AMG 108, which is a monoclonal antibody that blocks the action of IL-1.
  • Therapeutic agents also include excitatory amino acids such as glutamate and aspartate, antagonists or inhibitors of glutamate binding to NMDA receptors, AMPA receptors, and/or kainate receptors. It is contemplated that where desirable a pegylated form of the above may be used.
  • examples of other therapeutic agents include NF kappa B inhibitors such as glucocorticoids, antioxidants, such as dilhiocarbamate.
  • additional therapeutic agents suitable for use include, but are not limited to, an anabolic growth factor or anti-catabolic growth factor, analgesic agent, or an osteoinductive growth factor or a combination thereof.
  • Suitable anabolic growth or anti-catabolic growth factors include, but are not limited to, a bone morphogenetic protein, a growth differentiation factor, a LIM mineralization protein, CDMP or progenitor cells or a combination thereof.
  • Suitable analgesic agents include, but are not limited to, acetaminophen, bupivicaine, opioid analgesics such as amitriptyline, carbamazepine, gabapentin, pregabalin, clonidine, opioid analgesics or a combination thereof.
  • Opioid analgesics include, alfentanil, allylprodine, alphaprodine, anileridine, benzylmorphine, bezitramide, buprenorphine, butorphanol, clonitazene, codeine, desomorphine, dextromoramide, dezocine, diampromide, diamorphone, dihydrocodeine, dihydromorphine, dimenoxadol, dimepheptanol, dimethylthiambutene, dioxaphetyl butyrate, dipipanone, eptazocine, ethoheptazine, ethylmethylthiambutene, ethylmorphine, etonitazene, fentanyl, heroin, hydrocodone, hydromorphone, hydroxypethidine, isomethadone, ketobemidone, levorphanol, levophenacylmorphan, lofentanil, me
  • the release of each compound may be for at least one, at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine, at least ten, at least eleven, at least twelve, at least thirteen, at least fourteen, or at least fifteen days, or longer.
  • the drug depot may also be administered with non-active ingredients. These non-active ingredients may have multi-functional purposes including the carrying, stabilizing and controlling the release of the therapeutic agent(s).
  • the sustained release process for example, may be by a solution-diffusion mechanism or it may be governed by an erosion-sustained process.
  • the non-active ingredients will be durable within the tissue site for a period of time equal to (for biodegradable components) or greater than (for non-biodegradable components) the planned period of drug delivery.
  • the depot material may have a melting point or glass transition temperature close to or higher than body temperature, but lower than the decomposition or degradation temperature of the therapeutic agent.
  • the pre-determined erosion of the depot material can also be used to provide for slow release of the loaded therapeutic agent(s).
  • the drug depot may not be biodegradable or comprise material that is not biodegradable.
  • Non-biodegradable polymers include, but are not limited to, various cellulose derivatives (carboxymethyl cellulose, cellulose acetate, cellulose acetate propionate, ethyl cellulose, hydroxypropyl methyl cellulose, hydroxyalkyl methyl celluloses, and alkyl celluloses), silicon and silicon-based polymers (such as polydimethylsiloxane), polyethylene-co-(vinyl acetate), poloxamer, polyvinylpyrrolidone, poloxamine, polypropylene, polyamide, polyacetal, polyester, poly ethylene-chlorotrifluoroethylene, polytetrafluoroethylene (PTFE or "TeflonTM”), styrene butadiene rubber, polyethylene, polypropylene, polyphenylene oxide-polystyrene, poly- ⁇ -chloro-p-xylene,
  • the drug depot may comprise non-resorbable polymers as well.
  • These non-resorbable polymers can include, but are not limited to, delrin, polyurethane, copolymers of silicone and polyurethane, polyolefins (such as polyisobutylene and polyisoprene), acrylamides (such as polyacrylic acid and poly(acrylonitrile-acrylic acid)), neoprene, nitrile, acrylates (such as polyacrylates, poly(2-hydroxy ethyl methacrylate), methyl methacrylate, 2-hydroxyethyl methacrylate, and copolymers of acrylates with N-vinyl pyrrolidone), N-vinyl lactams, polyacrylonitrile, glucomannan gel, vulcanized rubber and combinations thereof.
  • polyurethanes include thermoplastic polyurethanes, aliphatic polyurethanes, segmented polyurethanes, hydrophilic polyurethanes, polyether-urethane, polycarbonate-urethane and silicone polyether-urethane.
  • the non-degradable drug depots may need to be removed.
  • the depot may comprise a biodegradable material.
  • a biodegradable material There are numerous materials available for this purpose and having the characteristic of being able to breakdown or disintegrate over a prolonged period of time when positioned at or near the target tissue.
  • the mechanism of the degradation process can be hydrolytical or enzymatical in nature, or both.
  • the degradation can occur either at the surface (heterogeneous or surface erosion) or uniformly throughout the drug delivery system depot (homogeneous or bulk erosion).
  • the depot may comprise a bioabsorbable, and/or a biodegradable biopolymer that may provide immediate release, or sustained release of the at least one analgesic agent and at least one anti-inflammatory agent.
  • suitable sustained release biopolymers include but are not limited to poly (alpha-hydroxy acids), poly (lactide-co-glycolide) (PLGA or PLG), polylactide (PLA), polyglycolide (PG), polyethylene glycol (PEG) conjugates of poly (alpha-hydroxy acids), polyorthoesters, polyaspirins, polyphosphagenes, collagen, starch, pre-gelatinized starch, hyaluronic acid, chitosans, gelatin, alginates, albumin, fibrin, vitamin E analogs, such as alpha tocopheryl acetate, d-alpha tocopheryl succinate, D,L-lactide, or L-lactide, poly(glycolide-,-caprolactone
  • polymers such as tri (e.g., PLGA-PEO-PLGA) or terpolymers
  • they may be used in different molar ratios, 1:1, 2:1, 3:1, 4:1, 5:1, 6:1, 7:1, 8:1, 9:1, or 10:1.
  • the polymer make up is 50:50 PLGA to 100 PLA.
  • the molecular weight range is 0.45 to 0.8 dI/g.
  • the molecular weight of the polymer can be a wide range of values.
  • the average molecular weight of the polymer can be from about 1000 to about 10,000,000; or about 1,000 to about 1,000,000; or about 5,000 to about 500,000; or about 10,000 to about 100,000; or about 20,000 to 50,000.
  • the at least one biodegradable polymer comprises poly(lactic-co-glycolic acid) (PLA) or poly(orthoester) (POE) or a combination thereof.
  • the poly(lactic-co-glycolic acid) may comprise a mixture of polyglycolide (PGA) and polylactide and in some embodiments, in the mixture, there is more polylactide than polyglycolide.
  • polylactide and 0% polyglycolide there is 100% polylactide and 0% polyglycolide; 95% polylactide and 5% polyglycolide; 90% polylactide and 10% polyglycolide; 85% polylactide and 15% polyglycolide; 80% polylactide and 20% polyglycolide; 75% polylactide and 25% polyglycolide; 70% polylactide and 30% polyglycolide; 65% polylactide and 35% polyglycolide; 60% polylactide and 40% polyglycolide; 55% polylactide and 45% polyglycolide; 50% polylactide and 50% polyglycolide; 45% polylactide and 55% polyglycolide; 40% polylactide and 60% polyglycolide; 35% polylactide and 65% polyglycolide; 30% polylactide and 70% polyglycolide; 25% polylactide and 75% polyglycolide; 20% polylactide and 80% polyglycolide; 15% polyl
  • polylactide there is at least 95% polylactide; at least 90% polylactide; at least 85% polylactide; at least 80% polylactide; at least 75% polylactide; at least 70% polylactide; at least 65% polylactide; at least 60% polylactide; at least 55%; at least 50% polylactide; at least 45% polylactide; at least 40% polylactide; at least 35% polylactide; at least 30% polylactide; at least 25% polylactide; at least 20% polylactide; at least 15% polylactide; at least 10% polylactide; or at least 5% polylactide; and the remainder of the biopolymer being polyglycolide.
  • the biodegradable polymer comprises at least 10 wt%, at least 50 wt.%, at least 60 wt.%, at least 70 wt.%, at least 80 wt.%, at least 85 wt.%, at least 90 wt.%, at least 95 wt.%, or at least 99 wt.% of the formulation.
  • the at least one biodegradable polymer and the analgesic and the anti-inflammatory are the only components of the pharmaceutical formulation.
  • At least 75% of the particles have a size from about 1 micrometer to about 250 micrometers. In some embodiments, at least 85% of the particles have a size from about 1 micrometer to about 100 micrometers. In some embodiments, at least 95% of the particles have a size from about 1 micrometer to about 30 micrometers. In some embodiments, all of the particles have a size from about 1 micrometer to about 30 micrometers.
  • At least 75% of the particles have a size from about 5 micrometer to about 20 micrometers. In some embodiments, at least 85% of the particles have a size from about 5 micrometers to about 20 micrometers. In some embodiments, at least 95% of the particles have a size from about 5 micrometer to about 20 micrometers. In some embodiments, all of the particles have a size from about 5 micrometer to about 20 micrometers.
  • the depot may optionally contain inactive materials such as buffering agents and pH adjusting agents such as potassium bicarbonate, potassium carbonate, potassium hydroxide, sodium acetate, sodium borate, sodium bicarbonate, sodium carbonate, sodium hydroxide or sodium phosphate; degradation/release modifiers; drug release adjusting agents; emulsifiers; preservatives such as benzalkonium chloride, chlorobutanol, phenylmercuric acetate and phenylmercuric nitrate, sodium bisulfite, sodium bisulfate, sodium thiosulfate, thimerosal, methylparaben, polyvinyl alcohol and phenylethyl alcohol; solubility adjusting agents; stabilizers; and/or cohesion modifiers.
  • buffering agents and pH adjusting agents such as potassium bicarbonate, potassium carbonate, potassium hydroxide, sodium acetate, sodium borate, sodium bicarbonate, sodium carbonate, sodium hydroxide or sodium phosphate
  • degradation/release modifiers
  • any such inactive materials will be present within the range of 0-75 wt %, and more typically within the range of 0-30 wt %.
  • the depot may comprise sterile preservative free material.
  • the depot can be different sizes, shapes and configurations, such as for example, strip, rod, sheet, mesh, or the like. There are several factors that can be taken into consideration in determining the size, shape and configuration of the drug depot. For example, both the size and shape may allow for ease in positioning the drug depot at the target tissue site that is selected as the implantation site. In addition, the shape and size of the system should be selected so as to minimize or prevent the drug depot from moving after implantation or injection. In various embodiments, the drug depot can be shaped like a pellet, a sphere, a cylinder such as a rod, a flat surface such as a disc, film or sheet, strip, rod, mesh, or the like. Flexibility may be a consideration so as to facilitate placement of the drug depot.
  • the drug depot can be different sizes, for example, the drug depot may be a length of from about 2 to 4 cm and width of from about 1-2 cm and thickness of from about 0.25 to 1 mm, or length of from about 0.5 mm to 5 cm and have a diameter of from about 0.01 to about 2 mm.
  • the depot is a strip having dimensions of 2.5 cm x 1.5 cm x 0.5 mm.
  • the drug depot may have a layer thickness of from about 0.005 to 1.0 mm, such as, for example, from 0.05 to 0.75 mm.
  • the surgeon accesses the target tissue site and threads a suture using a needle into the drug depot through the one or more channels, slits, loops, and/or clips or ties the suture around the one or more grooves, hooks, barbs, posts and/or clips of the drug depot then passes the suture and needle through the target tissue site and then anchors the drug depot at or near the target tissue site by tying a knot so as to limit the movement of the drug depot, even in areas where there is excessive blood flow, shifting of tissues during surgical site closure, or great movement of the tissue (e.g., in a joint or muscle area).
  • the needle is then removed and the suture cut and knotted leaving the suture and the drug depot in the desired position.
  • Figure 1 is a side sectional view of one embodiment of the implantable drug depot 10 having surface openings 12 and 13 that lead to channel 14 disposed in the center of the depot and adapted to receive one or more anchoring members, such as for example, a suture, yarn, thread, line or staple, which can pass into the target tissue site and anchor the drug depot at or near the target tissue site.
  • anchoring members such as for example, a suture, yarn, thread, line or staple
  • the surface can be a sufficient size to receive the anchoring member (e.g., suture, yarn, thread, line or staple).
  • the drug depot is shown as a rectangular shape. It will be understood by one or ordinary skill in the art that the drug depot can be any shape (e.g., pellet, oval, strip, rod, sheet, mesh, or the like).
  • the attachment surface of the drug depot can include one or more ports, grooves, slits, loops, hooks, barbs, posts and/or clips instead of the channel (shown in Figure 1 ) adapted to receive the one or more anchoring members.
  • the attachment surface of the drug depot may be an extension from the drug depot 10.
  • the one or more channels, grooves, slits, loops, hooks, barbs, posts and/or clips can be made of the same or different material than the drug depot.
  • the one or more anchoring members e.g., suture, yarn, line, etc.
  • suture, yarn, line, etc. can be made of the same or different material as the drug depot.
  • Surgical procedures can be used to attach the drug depot at or near the target tissue site.
  • a suture is threaded through the channel disposed through the drug depot. The suture anchors the drug depot 10 to the target tissue site.
  • the drug depot may be attached to the suture before or after the drug depot is affixed to the anatomical structure or target tissue plane.
  • the drug depot can be positioned inside the body of a patient under the skin and against a tissue plane, and a needle having the suture is passed through the drug depot surface and then into the anatomical site to anchor the drug depot at or near the target tissue site. After the needle is pierced through a body tissue, the needle is cut off, and knots are fastened according to surgical fastening methods.
  • Figure 1A is a side sectional view of one embodiment of the implantable drug depot 10 having surface openings 12 and 13 that lead to channel 14, which is adapted to receive a needle 20 having an anchoring member such as a suture 16 attached thereto that is passed through opening 12 through channel 14 and out of opening 13 of the drug depot.
  • the needle and suture extend from the channel, where the needle can pierce a target tissue site.
  • the suture 16 can comprise a portion or region (e.g., knot, rim, bead, clip, ridge, tab, or the like) that allows the suture to be pulled taut while holding the suture in place. This portion of the suture prevents both ends of the suture from passing through the drug depot.
  • Shown in Figure 1A is a knot 18, that the surgeon may tie or the knot may be made beforehand when the drug depot is pre-threaded with suture, yarn, thread, line, wire, or the like. In this way, the surgeon only needs to pierce the target tissue site with the needle and tie the drug depot to the target tissue site via a knot, without fear that if the suture is pulled too hard, the suture will be pulled out of the depot.
  • one end of the suture can comprise a knot, rim, bead or clip that is larger than the channel to prevent the suture from being pulled through the channel of the drug depot.
  • Figure 2 is a side sectional view of one embodiment of the implantable drug depot 10 having surface openings 12 and 13 that lead to channel 14, which is adapted to receive a needle 20 having an anchoring member such as a suture 16 attached thereto that is passed through opening 12 through channel 14 and out of opening 13 of the drug depot.
  • a needle 20 having an anchoring member such as a suture 16 attached thereto that is passed through opening 12 through channel 14 and out of opening 13 of the drug depot.
  • the needle and suture extend from the channel, where the needle can pierce a target tissue site.
  • the suture 16 can be looped and knotted at, near or against a target tissue.
  • Shown in Figure 2 is a knot 18, that the surgeon may tie or the knot may be made beforehand when the drug depot is pre-threaded with suture, yarn, thread, line, wire, or the like.
  • Shown in Figure 2 at 18 is a region of the suture that is larger in circumference and/or diameter than the channel of the depot and thus prevents the suture from being pulled through the drug depot.
  • the needle can pierce the target tissue site first, then the needle and suture can be used to thread the drug depot channel, which acts as a guide for the surgeon or be tied around the drug depot. The surgeon can then can tie the drug depot to the target tissue site and knot and cut the suture to anchor the drug depot at or near the target tissue site.
  • FIG. 2A is a side sectional view of one embodiment of the implantable drug depot 10.
  • the pull and cut system is illustrated.
  • the drug depot has a surface, in this case a channel 14, disposed in the center of the depot to receive a suture 16 as the anchoring member.
  • the suture in this illustration has two regions 17 and 18 that are pre-knotted.
  • the suture regions are spaced a distance from each other so as to allow the depot to be sutured and pulled on, in, or through the one or more surfaces (e.g., channels) of the depot.
  • the depot can be spaced 0.5 mm, 1 mm, 5 mm, 10 mm, 20 mm, 50 mm, 100 mm or 1 cm, 5 cm, or 10 cm apart from each other depending on the depth of the target tissue site.
  • the drug depot is suitable for laparoscopic, arthroscopic, neuroendoscopic, endoscopic, rectoscopic procedures or the like.
  • Anchoring means include, for example, grooves, slits, loops, hooks, eyelets, barbs, posts, tabs, clips, or the like can be used in conjunction with or instead of the channels.
  • one or more grooves, slits, loops, hooks, eyelets, barbs, posts, tabs, and/or clips can be disposed on, in or above the top and/or bottom surfaces of the drug depot to facilitates the anchoring member being attached to or through the drug depot (e.g., the surgeon can slip the suture region under a clip, hook, tab, or barb extending from the drug depot to anchor the depot to the target tissue site).
  • FIG. 2B is a side sectional view of one embodiment of the implantable drug depot 10.
  • the pull and cut system is illustrated, where the suture is pulled through the depot.
  • the drug depot has a surface, in this case a channel 14, disposed in the center of the depot to receive a suture 16 as the anchoring member.
  • the suture in this illustration has two regions 17 and 18 that are pre-knotted. One of the regions 18 holds the suture in place inside the depot and the other region 17 travels with the needle, when the needle pierces the target tissue site. After piercing the tissue site, the surgeon returns the suture to opening 13 and through channel 14 and out through opening 12. Pulling the suture taut forces knot 17 through opening 12 and locks the suture in place. After pulling, all the surgeon need do is cut the suture adjacent to the exposed knot to implant the depot.
  • the suture can have other locking means adapted to hold the suture at different position in the depot.
  • Such locking means disposed along the regions of the suture include, but are not limited to, one or more hooks, barbs, posts, beads, tabs, rims, clips, and/or ridges, or the like that are adapted to hold the suture in position.
  • the suture can have two hooks, barbs, posts, beads, tabs, rims, clips, or ridges that are larger than the channels so that one will hold the suture within the depot and the other the surgeon forces through the channel of the depot by pulling the suture taut to lock the depot at a target tissue site.
  • these hooks, barbs, posts, beads, tabs, rims, clips, and/or ridges, or the like may be made of biodegradable material as the depot and the suture.
  • Figure 3 is a side sectional view of one embodiment of the implantable drug depot 10 having two surface openings 13 and 15 that lead to two channels at opposite ends shown as 14 and 24, which are adapted to receive a needle 20 having an anchoring member such as a suture 16 attached thereto that is passed through opening 12 through channel 14 and out of opening 13 of the drug depot.
  • a needle 20 having an anchoring member such as a suture 16 attached thereto that is passed through opening 12 through channel 14 and out of opening 13 of the drug depot.
  • the needle and suture extend from the channel, where the needle can pierce a target tissue site and then return to unfilled attachment surface opening 15 and be passed through channel 24 out to opening 22, where the suture can be looped and knotted at, near or against a target tissue.
  • Shown in Figure 3 is a knot 18, that the surgeon may tie and then pass the needle and suture through the channel 14 or the knot may be made beforehand when the drug depot is pre-threaded with suture, yarn, thread, line, wire, or the like.
  • the surgeon only needs to pierce the target tissue site with the needle and then return the needle and suture to unfilled opening 15 and channel 24 will guide the needle and suture through the drug depot out the surface opening 22, where the drug depot can be anchored in place at or near the target tissue site via a knot.
  • This is one embodiment of the drug depot's easy tie system, where surgical steps of threading the needle and depot are eliminated because the needle, suture and depot are pre-threaded.
  • Shown in Figure 3 at 18 is a region of the suture that is larger in size (e.g., in circumference and/or diameter) than the channel of the depot and thus prevents the suture from being pulled through the drug depot.
  • the surgeon uses the needle and suture to pierce the target tissue site and then the same needle and suture is threaded through second opening 15 and second channel 24 acts as a guide to allow the suture out opening 22, where a knot can be tied by the surgeon and the suture can be pulled taut so that the drug depot can be sutured and anchored at or near the target tissue site.
  • the openings in the channels have the geometry to allow the anchoring member to pass therethrough.
  • Figure 4 is a side sectional view of one embodiment of the implantable drug depot 10 having two surface openings 13 and 15 that lead to two channels at opposite ends shown as 14 and 24, which are adapted to receive a needle 20 having an anchoring member such as a suture 16 attached thereto that is passed through opening 12 through channel 14 and out of opening 13 of the drug depot.
  • the needle and suture extend from the channel, where the needle can pierce a target tissue site and then return to attachment surface opening 15 and be passed through channel 24 out to opening 22, where the suture can be looped and knotted at, near or against a target tissue.
  • Shown in Figure 4 is a knot 18, that the surgeon may tie and then pass the needle and suture through the channel 14 or the knot may be made beforehand when the drug depot is pre-threaded with suture, yarn, thread, line, wire, or the like.
  • the surgeon only needs to pierce the target tissue site with the needle and then return the needle and suture to unfilled opening 15 and channel 24 will guide the needle and suture through the drug depot out the surface of opening 22, where a knot can be made to anchor the drug depot.
  • This is one embodiment of the drug depot's easy tie system, where there are reduced steps in surgery of pre-threading the needle with the suture and pre-threading the drug depot with the needle.
  • Shown in Figure 4 at 18 is a region of the suture that is larger in size (e.g., in circumference and/or diameter of the channel of the depot and thus prevents the suture from being pulled through the drug depot.
  • the surgeon uses the needle and suture to pierce the target tissue site and then the same needle and suture is threaded through second opening 13 and second channel 14 acts as a guide to allow the suture out opening 12, where a knot can be tied by the surgeon and the suture can be pulled taut so that the drug depot can be sutured and anchored at or near the target tissue site.
  • the drug depot can be positioned inside the body of a patient under the skin and against a tissue plane, and a needle having the suture is passed through the drug depot surface and then into the anatomical site to anchor the drug depot at or near the target tissue site. After the needle has pierced through a body tissue, the needle and suture are used to thread the drug depot via the second channel and a knot is made and the needle is cut off from the suture according to surgical fastening methods.
  • the anchoring member can be a staple and the drug depot surface is adapted to receive the staple or the staple can pierce the drug depot and the target tissue site to anchor the drug depot.
  • the surgeon can place the drug depot against the target tissue site and then staple the drug depot to the target tissue site. In this way the surgeon can easily implant the drug depot.
  • Figure 4A is a side sectional view of one embodiment of the implantable drug depot 10 having two surface openings 13 and 15 that lead to two channels (14 and 24) and openings 22 and 12 , which are adapted to receive a needle having an anchoring member such as a suture 16 that is passed through opening 12 through channel 14 and out of opening 13 of the drug depot.
  • the needle and suture extend from the channel, where the needle can pierce a target tissue site beneath the skin 22.
  • the target tissue site comprises muscles tissue 24.
  • the needle and suture pierce the muscle tissue and then return to attachment surface at the other end of the depot opening 15 and is guided through channel 24 out to opening 22, where the suture can be looped and knotted at, near or against a target tissue.
  • Shown in Figure 4A is a bead 18 that is used to pre-attach the suture to one end of the drug depot.
  • This bead is attached to a region of the suture and is larger than the channel and opening so that the surgeon cannot pull this end of the suture out of the drug depot.
  • the surgeon pierces the muscle tissue 24 with the needle, the surgeon brings the needle and suture back through second opening 15 and the needle and suture are guided through channel 24 out opening 22 and the surgeon knots the suture and cuts the needle and suture to anchor the drug depot at or near the target tissue site.
  • the drug depot can be biodegradable and as the drug depot degrades, drug is released at the target tissue site and unwanted migration and consistent drug therapy is provided at or near the target tissue site.
  • the suture 16 degrades faster than the drug depot so that as the target tissue site heals, the suture will degrade leaving the drug depot lodged deep within the target tissue site to release drug as bodily fluid contacts the drug depot and causes it to degrade over time.
  • the suture is pre-attached to the surgical needle and the suture is pre-threaded through or pre-attached to the one or more channels, slits, loops, and/or clips or is pre-tied around or pre-attached to the one or more grooves, hooks, barbs, posts and/or clips so as to eliminate some surgical steps and reduce the length of time during surgery.
  • FIG. 5 is a side view of one embodiment of the implantable drug depot 10 having two surfaces, in this case two channels openings shown as 12 and 22, disposed at different ends of the drug depot that can receive a suture 16.
  • the suture has two regions, one region 18 to hold the suture in place in the depot and the other region 17 (after piercing the body tissue with needle 20) the surgeon pulls through the channel opening 22 to force region 17 through the opening and lock the depot in place at or near a target tissue site.
  • This illustration shows the depot pre-threaded and pre-knotted (17 and 18). All the surgeon need do after pulling the suture through the channel is cut the suture. This "pull and cut" system avoids time-consuming steps of tying knots to anchor the depot during surgery.
  • Figure 5A is a side view of one embodiment of the implantable drug depot 10 having two surfaces, in this case two channels openings shown as 12 and 22, disposed at different ends of the drug depot that can receive a suture 16.
  • the suture has two regions, one region 18 to hold the suture in place in the depot and the other region 17 (after piercing the body tissue with needle 20) the surgeon pulls through the channel opening 22 to force region 17 through the opening and lock the depot in place at or near a target tissue site.
  • This illustration shows the depot pre-threaded and pre-knotted (17 and 18) and suture needle 20 passing through channel opening 22. All the surgeon need do after pulling the suture through the channel is cut the suture.
  • FIGs 5B , 5C and 5D illustrate back views of one embodiment of the implantable drug depot 10 as the suture 16 and needle 20 pass through the channel opening 13.
  • the suture has a region 17 (after piercing the body tissue) that the surgeon pulls and forces it through opening 15 and locks the depot in place at or near a target tissue site.
  • This illustration shows the depot pre-threaded and pre-knotted and suture needle passed through channel opening 15 and region 17 about to be pulled through ( Figures 5B and 5C ).
  • Figure 5D shows the suture 16 and needle 20 pulled through the channel opening 15 of the drug depot 10. This back part of the depot, in some embodiments, is implanted against the tissue plane.
  • Figure 5E illustrates a front view of one embodiment of the implantable drug depot 10 having two surfaces, in this case two channels openings shown as 12 and 22, disposed at different ends of the drug depot that receive a suture 16.
  • the suture has two regions, one region 18 to hold the suture in place in the depot and the other region 17 (after piercing the body tissue with needle 20) the surgeon pulls through the channel opening 22 to force region 17 through the opening and lock the depot in place at or near a target tissue site.
  • This illustration shows the depot pre-threaded and pre-knotted (17 and 18) and the suture being cut adjacent to knot 17.
  • FIGs 5F and 5G illustrate a front view of one embodiment of the drug depot 10 implanted at a target tissue site (muscle 24 in Figure 5G ) beneath the skin (22 in Figure 5G ).
  • the drug depot has two surfaces, in this case two channels openings shown as 12 and 22, disposed at different ends of the drug depot that receive a suture 16.
  • the suture has two regions, one region 18 to hold the suture in place in the depot and the other region 17 (after piercing the body tissue with needle 20) the surgeon pulls through the channel opening 22 to force region 17 through the opening and lock the depot in place at or near a target tissue site.
  • the illustration in Figure 5F shows the depot pre-threaded and pre-knotted (17 and 18) and implanted and the suture being cut adjacent to knot 17.
  • Figure 5G illustrates the depot implanted after excess suture and the needle are removed.
  • the depot may have the holes, channels, grooves, slits, or the like pre-made in it that is done by the manufacturer.
  • the holes, channels, grooves, slits, or the like can be made by the user using the needle.
  • the holes, channels, grooves, slits, or the like can be made by punching, drilling, laser, or the like.
  • the suture and needle can be attached by hand or automated machine.
  • Suture knots can be created by hand or automated machine.
  • Other capture means or mechanisms can be pre-molded into depot implant shape, machined in, or attached secondarily.
  • the surface of the drug depot can be one or more grooves, slits, loops, hooks, eyelets, barbs, posts or the like as long as the surface facilitates the anchoring member being attached to or through the drug depot.
  • the at least one attachment surface of the drug depot may extend from the body of the drug depot, such as for example, in a channel, loop, hook, eyelet, barb, post, structure or the like.
  • the one or more channels, grooves, slits, loops, hooks, eyelets, barbs, posts and/or clips of the drug depot may be spaced apart equidistant from each other.
  • the one or more channels, grooves, slits, loops, hooks, eyelets, barbs, posts and/or clips may be spaced apart by 0.5mm, 1mm, 5mm, 10mm, 20mm from each other.
  • Figure 6A is a side view of one embodiment of the implantable drug depot 10 having a surface adapted to receive a suture 16, where the surgeon can tie the suture to the depot shown as a knot 18 at one end and the other end 22 of the suture can be attached to a needle, which is used to pierce the target tissue site and the suture end 22 can be tied in a knot and the needle cut and removed.
  • the drug depot can be anchored at or near the target tissue.
  • Figure 6B is a side view of one embodiment of the implantable drug depot 10 having a surface, in this case a groove 24 running around the circumference of the drug depot, adapted to receive a suture 16 where the suture can be tied 18 around groove 24 and one end of the suture 22 can be threaded through a needle.
  • the needle and suture can pierce the target tissue site and the needle and suture returned and the suture knotted and the needle cut and removed.
  • the drug depot can be sutured at or near the target tissue site.
  • the drug depot can have the suture pre-attached to the drug depot saving the surgeon surgical steps and time in threading the needle and the drug depot.
  • Radiographic markers can be included on the drug depot to permit the user to position the depot accurately into the target site of the patient. These radiographic markers will also permit the user to track movement and degradation of the depot at the site over time. In this embodiment, the user may accurately position the depot in the site using any of the numerous diagnostic imaging procedures. Such diagnostic imaging procedures include, for example, X-ray imaging, fluoroscopy, or MRI. Examples of such radiographic markers include, but are not limited to, barium, calcium phosphate, and/or metal beads or particles. In various embodiments, the radiographic marker could be a spherical shape, a line(s), or a ring around the depot.
  • the drug depot may have an initial burst effect to release the drug shortly after it is implanted.
  • the initial burst can be controlled by factors related to the property of the depot, such as the water immiscibility of the solvent, polymer/solvent ratio, and the property of the polymer.
  • the extent of water immiscibility of the solvent used in the depot affects that rate aqueous body fluid can penetrate the depot to release the therapeutic agent.
  • higher water solubility leads to a higher initial burst while water immiscibility leads to a lower initial burst or slower release (sustained release) of the therapeutic agent.
  • Suitable solvents that can be used to control initial burst release or sustained release include, but are not limited to, methyl benzoate, ethyl benzoate, n-propyl benzoate, isopropyl benzoate, butyl benzoate, isobutyl benzoate, sec-butyl benzoate, tert-butyl benzoate, isoamyl benzoate, benzyl benzoate, water, alcohol, low molecular weight PEG (less than 1,000 MW), triacetin, diacetin, tributyrin, triethyl citrate, tributyl citrate, acetyl triethyl citrate, acetyl tributyl citrate, triethylglycerides, triethyl phosphate, diethyl phthalate, diethyl tartrate, mineral oil, polybutene, silicone fluid, glycerin, ethylene glycol, octanol,
  • the depot may have pore forming agents, which include biocompatible materials that when contacted with body fluids dissolve, disperse or degrade to create pores or channels in the polymer matrix.
  • biocompatible materials that when contacted with body fluids dissolve, disperse or degrade to create pores or channels in the polymer matrix.
  • organic and non-organic materials that are water soluble such as sugars (e.g., sucrose, dextrose), water soluble salts (e.g., sodium chloride, sodium phosphate, potassium chloride, and sodium carbonate), water soluble solvents such as N-methyl-2-pyrrolidone and polyethylene glycol and water soluble polymers (e.g., carboxymethylcellulose, hydroxypropyl-cellulose, and the like) can conveniently be used as pore formers.
  • Such materials may be present in amounts varying from about 0.1% to about 100% of the weight of the polymer, but will typically be less than 50% and more typically less than 10-20% of the weight of polymer.
  • varying the molecular weight of the polymer in the depot, or adjusting the molecular weight distribution of the polymer material in the depot vehicle can affect the initial burst and the release rate of therapeutic agent from the depot. Generally, a higher molecular weight polymer renders a lower initial burst and slower release rate of the therapeutic agent.
  • the polymers may have different end groups such as acid and ester end groups. As persons of ordinary skill in the art are aware, implantable elastomeric depot compositions having a blend of polymers with different end groups are used the resulting formulation will have a lower burst index and a regulated duration of delivery. For example, one may use polymers with acid (e.g., carboxylic acid) and ester end groups (e.g., methyl of ethyl ester end groups).
  • the comonomer ratio of the various monomers that form a polymer e.g., the L/G (lactic acid/glycolic acid) or G/CL (glycolic acid/polycaprolactone) ratio for a given polymer
  • L/G lactic acid/glycolic acid
  • G/CL glycolic acid/polycaprolactone
  • a depot composition having a polymer with a L/G ratio of 50:50 may have a short duration of delivery ranging from about two days to about one month; a depot composition having a polymer with a L/G ratio of 65:35 may have a duration of delivery of about two months; a depot composition having a polymer with a L/G ratio of 75:25 or L/CL ratio of 75:25 may have a duration of delivery of about three months to about four months; a depot composition having a polymer ratio with a L/G ratio of 85:15 may have a duration of delivery of about five months; a depot composition having a polymer with a L/CL ratio of 25:75 or PLA may have a duration of delivery greater than or equal to six months; a depot composition having a terpolymer of CL/G/L with G greater than 50% and L greater than 10% may have a duration of delivery of about one month and a depot composition having a terpolymer of CL/G/L with G less than 50% and L less less than
  • depot compositions having a blend of polymers having different molecular weights, end groups and comonomer ratios can be used to create a depot formulation having a lower burst index and a regulated duration of delivery.
  • Factors such as the particle size, the disintegration of the particulates, the morphology of the particulates (e.g., whether pores are present in the particulates before implanting or can be formed easily by body fluid attack), coatings, complex formation by the therapeutic agent and the strength of complex bond, can be manipulated to achieve the desired low initial burst and release rate.
  • Suture may be resorbable or permanent in nature depending upon the type of material from which it is made.
  • suture refers to any flexible structure that can be stretched between two points and includes, without limitation, traditional suture material, single or multiple stranded threads, or a mesh structure.
  • a suture may also be a strap-like structure with a number of holes in it, similar to the holes found in a belt.
  • a "suture” may also take the form of an acellular, collagen membrane or other biologic tissue augment, which may provide a scaffold or support matrix for cellular ingrowth to allow soft tissue to reconstruct itself.
  • Sutures for attachment to surgical needle include silk, nylon, linen, cotton, chromic gut, plain gut, cat gut, vicryl, polyglactin, polyester, polypropylene, stainless steel, synthetic polymers having glycolic acid ester linkages subject to hydrolytic degradation to non-toxic tissue compatible absorbable components, including polyglycolic acid.
  • the sutures may be monofilamentary or braided, absorbable or non-absorbable.
  • the suture may be of any length. In various embodiments, the suture is long enough to reach from the site of placement of the depot to the target tissue site.
  • the suture may be of any thickness provided it can be attached to or pass through the drug depot. In some embodiments, the suture may be coated with a drug.
  • bioabsorbable polymers can be used to make the suture.
  • suitable biocompatible, bioabsorbable polymers include aliphatic polyesters, poly(amino acids), copoly(ether-esters), polyalkylenes oxalates, polyamides, tyrosine derived polycarbonates, poly(iminocarbonates), polyorthoesters, polyoxaesters, polyamidoesters, polyoxaesters containing amine groups, poly(anhydrides), polyphosphazenes, biomolecules (i.e., biopolymers such as collagen, elastin, bioabsorbable starches, etc.) or blends thereof.
  • Polyesters include, but are not limited to, homopolymers and copolymers of lactide (which includes lactic acid, D-,L- and meso lactide), glycolide (including glycolic acid), caprolactone, p-dioxanone (1,4-dioxan-2-one), trimethylene carbonate (1,3-dioxan-2-one), alkyl derivatives of trimethylene carbonate, delta-valerolactone, beta-butyrolactone, gamma-butyrolactone, epsilon-decalactone, hydroxybutyrate, hydroxyvalerate, 1,4-dioxepan-2-one (including its dimer 1,5,8,12-tetraoxacyclotetradecane-7,14-dione), 1,5-dioxepan-2-one, 6,6-dimethyl- 1,4-dioxan-2-one 2,5-diketomorpholine, pivalolactone, alpha-diethyl
  • the suture can comprise shape memory polymers including various polyethers, polyacrylates, polyamides, polysiloxanes, polyurethanes, polyether amides, polyurethane/ureas, polyether esters, or urethane/butadiene copolymers or a combination thereof.
  • the suture degrades faster than the drug depot. In some embodiments, the drug depot degrades faster than the suture.
  • Sutures may be of different sizes depending on the procedure being performed and the implant site. Sutures can range in size from #000000 (#6-0 or #6/0), #00 (#2-0 or #2/0), #0, #1, #2, #3, #4, #5, #6, with #000000 being the smallest.
  • the drug depot will have one or more channels, grooves, slits, loops, hooks, and /or barbs that will be larger than #000000, #00, #0, #1, #2, #3, #4, #5, or #6, range so that the suture can pass through the surface of the drug depot.
  • the one or more channels, grooves, slits, loops, hooks, eyelets, barbs, posts and/or clips are such a size that allows a needle having a suture, yarn, thread, or line pass and be guided through or around the depot.
  • the one or more channels, grooves, slits, loops, hooks, eyelets, barbs, posts and/or clips may be larger than the needle width and/or thickness and act as a guide for the surgeon to pass the needle therethrough.
  • the dimensions of the needle will depend on the site for implantation. For example, the width of the muscle planes in different surgical procedures can vary from 1-40 cm. Thus, the needle, in various embodiments, can be designed for these specific areas.
  • Needles may have different shapes such as for example half curved or ski shaped, 1/4 circle, 3/8 circle, 1/2 circle, 5/8 circle, compound curve or the like.
  • the drug depot surfaces will be designed to receive the needle and suture so that the needle and suture can pass through the drug depot or allow the suture to be tied around it.
  • the thickness of the needle will also depend on the site of implantation. In various embodiments, the thickness includes, but is not limited to, from about 0.05 to about 1.655.
  • the gauge of the needle may be the widest or smallest diameter or a diameter in between for insertion into a human or animal body. The widest diameter is typically about 14 gauge, while the smallest diameter is about 25 gauge. In various embodiments the gauge of the needle or cannula is about 18 to about 22 gauge.
  • the one or more channels, grooves, slits, loops, hooks, eyelets, barbs, posts and/or clips may have a size larger than this so the needle having the suture can pass through it.
  • a knot can be made and the needle is cut off from the suture according to surgical fastening methods.
  • Suturing needles for applying sutures, or stitches, by hand or via an automated device, such as for example in arthroscopic surgeries can be used in the present application.
  • Suturing needles are usually made from a cut blank of material, such as for example, polyurethane, polyurea, polyether(amide), PEBA, thermoplastic elastomeric olefin, copolyester, and styrenic thermoplastic elastomer, steel, aluminum, stainless steel, titanium, metal alloys with high non-ferrous metal content and a low relative proportion of iron, carbon fiber, glass fiber, plastics, ceramics or combinations thereof.
  • the needle may optionally include one or more tapered regions.
  • the needle generally includes a shaft, a rear end portion with an aperture or channel to secure a suture thread and a needle head at a front end portion for puncturing skin and passing through tissue.
  • the needle head typically incorporates a sharpened needle tip at its distal end and cutting edges.
  • the needle tip may be of a tapered configuration.
  • Straight and curved needles including multiple curved configurations are also known in the art.
  • Suture needles typically incorporate a sharpened needle end. Sharper needles require less force to penetrate tissue and thus cause less tissue trauma. In addition, a sharper needle reduces fatigue on the needle itself, making it less likely to bend or break during suturing.
  • Needle sharpness is typically defined in terms of "penetration force"--the force necessary for a needle to puncture, or penetrate, the tissue.
  • the penetration force is primarily determined by the design and sharpness of the needle point and the cutting edges formed on the needle head. Needle sharpness is also affected by drag force on the needle as it travels through the tissue. The drag force also depends upon the design and sharpness of the needle, and the presence of a lubricating coating.
  • the choice of materials of surgical needle is made to optimize strength, ductility and resistance to bending or breaking of the needle. However, the cross-sectional shape and dimensions of the needle contributes significantly to the physical characteristics of the needle.
  • the needle includes stainless steel such as series "300" stainless steels, which typically have tensile strengths of between 325,000-350,000 lbs/in 2 .
  • the suture needle is metal such as, for example, stainless steal
  • the needle cam be manufactured through conventional cutting, coining, grinding and/or swaging processes, and may be heat treated to further enhance its strength and resistance to bending.
  • a lubricious coating such as silicon may be applied to needle body to further enhance penetration and drag characteristics.
  • the drug depot, medical device to administer the drug, and/or anchoring members may be sterilizable.
  • one or more components of the drug depot, medical device to administer the drug, and/or anchoring members (e.g., suture) may be sterilizable by radiation in a terminal sterilization step in the final packaging. Terminal sterilization of a product provides greater assurance of sterility than from processes such as an aseptic process, which require individual product components to be sterilized separately and the final package assembled in a sterile environment.
  • gamma radiation is used in the terminal sterilization step, which involves utilizing ionizing energy from gamma rays that penetrates deeply in the device.
  • Gamma rays are highly effective in killing microorganisms, they leave no residues nor have sufficient energy to impart radioactivity to the device.
  • Gamma rays can be employed when the device is in the package and gamma sterilization does not require high pressures or vacuum conditions, thus, package seals and other components are not stressed.
  • gamma radiation eliminates the need for permeable packaging materials.
  • the suture, depot and needle is pre-assembled, packaged in a moisture resistant package and then terminally sterilized by gamma irradiation. In use the surgeon removes the pre-assembled drug depot from the sterile package for use.
  • electron beam (e-beam) radiation may be used to sterilize one or more components of the device.
  • E-beam radiation comprises a form of ionizing energy, which is generally characterized by low penetration and high-dose rates.
  • E-beam irradiation is similar to gamma processing in that it alters various chemical and molecular bonds on contact, including the reproductive cells of microorganisms. Beams produced for e-beam sterilization are concentrated, highly-charged streams of electrons generated by the acceleration and conversion of electricity.
  • kits may also be used to sterilize the depot and/or one or more components of the device, including, but not limited to, gas sterilization, such as, for example, with ethylene oxide or steam sterilization.
  • gas sterilization such as, for example, with ethylene oxide or steam sterilization.
  • a kit comprising one or more drug depots having surfaces adapted to receive one or more anchoring members.
  • the kit may include additional parts along with the drug depot and/or medical device combined together to be used to implant the drug depots (e.g ., pellets, strips, meshes etc. ).
  • the kit may include the drug depot device in a first compartment.
  • the second compartment may include a canister holding the drug depots or each drug depot with a different release profile may be labeled and placed in a different compartment (e.g ., bolus dose depot compartment, sustained release depot compartment, etc. ) and any other instruments needed for the localized drug delivery.
  • a third compartment may include gloves, drapes, wound dressings and other procedural supplies for maintaining sterility of the implanting process, as well as an instruction booklet.
  • a fourth compartment may include additional needles and/or sutures. Each tool may be separately packaged in a plastic pouch that is radiation sterilized.
  • a fifth compartment may include an agent for radiographic imaging.
  • a cover of the kit may include illustrations of the implanting procedure and a clear plastic cover may be placed over the compartments to maintain sterility.
  • the drug depot may be parenterally administered.
  • parenteral refers to modes of administration, which bypass the gastrointestinal tract, and include for example, intramuscular, intraperitoneal, intrasternal, subcutaneous, intra-operatively, intrathecally, intradiskally, peridiskally, epidurally, perispinally, intraarticular or combinations thereof.
  • therapeutically effective doses may be less than doses administered by other routes (oral, topical, etc. ).
  • systemic side effects such as for example, liver transaminase elevations, hepatitis, liver failure, myopathy, constipation, etc. may be reduced or eliminated.
  • the drug depot can be delivered to any site beneath the skin, including, but not limited to, at least one muscle, ligament, tendon, cartilage, spinal disc, spinal foraminal space, near the spinal nerve root, or spinal canal.
  • a method of treating or preventing postoperative pain or inflammation in a patient in need of such treatment comprising suturing one or more biodegradable drug depots comprising a therapeutically effective amount of an analgesic and/or anti-inflammatory agent or pharmaceutically acceptable salt thereof at or near a target tissue site beneath the skin, wherein the drug depot comprises at least one surface adapted to receive one or more sutures so as to limit movement of the drug depot at or near the target tissue site and the drug depot is capable of releasing the analgesic and/or anti-inflammatory agent or pharmaceutically acceptable salt thereof over a period of at least 3 days.
  • Another embodiment provides a method for treating a mammal suffering from inflammation and/or pain, said method comprising administering a therapeutically effective amount of at least one analgesic agent and at least one anti-inflammatory agent at a target site beneath the skin at or near the target site.
  • the at least one analgesic agent and at least one anti-inflammatory agent may for example be administered locally to the target tissue site as a drug depot.
  • the therapeutically effective dosage amount and the release rate profile are sufficient to reduce inflammation and/or pain for a period of at least one day, for example, 1-90 days, 1-10 days, 1-3 days, 3-7 days, 3-12 days; 3-14 days, 7-10 days, 7-14 days, 7-21 days, 7-30 days, 7-50 days, 7-90 days, 7-140 days, or 14-140 days.
  • the at least one analgesic agent and at least one anti-inflammatory agent or a portion of the at least one analgesic agent and at least one anti-inflammatory agent are administered as a bolus dose at the target tissue to provide an immediate release of the at least one analgesic agent and at least one anti-inflammatory agent.
  • composition useful for the treatment of inflammation comprising an effective amount of at least one analgesic agent and at least one anti-inflammatory agent that is capable of being administered to e.g ., a pain or inflammatory site.
  • analgesic agent capable of being administered to e.g ., a pain or inflammatory site.
  • anti-inflammatory agent capable of being administered to e.g ., a pain or inflammatory site.
  • they may be administered locally to the foraminal spine, paraspinal muscles or subcutaneous tissues.
  • the at least one analgesic agent and/or at least one anti-inflammatory agent are administered by placement into an open patient cavity during surgery.
  • the drug depot can be placed at postions around the pain generator using a strategy of triangulation.
  • a strategy of triangulation may be effective when administering multiple depot pharmaceutical formulations.
  • a plurality (at least two, at least three, at least four, at least five, at least six, at least seven, etc. ) drug depots comprising the pharmaceutical formulations may be placed around the target tissue site (also known as the pain generator or pain generation site) such that the target tissue site falls within a region that is either between the formulations when there are two, or within an area whose perimeter is defined by a set of plurality of formulations.
  • the formulation is implantable at or near a target tissue site at the time of surgery.
  • the active ingredients may then be released from the depot via diffusion in a sustained fashion over a period of time, e.g ., 1-3 days, 3-15 days, 5-10 days or 7-10 days post surgery in order to address pain and inflammation.
  • a desired release profile is maintained for at least three days, at least ten days, at least twenty days, at least thirty days, at least forty days, at least fifty days, at least ninety days, at least one hundred days, at least one-hundred and thirty-five days, at least one-hundred and fifty days, or at least one hundred and eighty days.
  • the drug depot may release 5%, 10%, 15%, 20%, 25%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, or 99% of the at least one analgesic agent or pharmaceutically acceptable salt thereof and at least one anti-inflammatory agent or pharmaceutically acceptable salt thereof relative to a total amount of at least one analgesic agent or pharmaceutically acceptable salt thereof and at least one anti-inflammatory agent loaded in the drug depot over a period of at least three days, at least seven days, at least ten days, at least twenty days, at least thirty days, at least forty days, at least fifty days, at least ninety days, at least one hundred days, at least one-hundred and thirty-five days, at least one-hundred and fifty days, or at least one hundred and eighty days.
  • the analgesic will be released in an initial burst dose, then the analgesic will be released daily for 3 days and then stop ( e.g ., this will be suitable to reduce, prevent or treat, post-operative pain), while the anti-inflammatory agent will be released daily without a burst dose for 3 to 12 days, 5 to 10 days or 7 to 10 days after the drug depot is administered to the target tissue site.
  • an implantable drug depot useful for reducing, preventing or treating pain and inflammation is provided in a patient in need of such treatment, the implantable drug depot comprising a therapeutically effective amount of an analgesic and/or an anti-inflammatory agent or pharmaceutically acceptable salts thereof, the depot being implantable at a site beneath the skin to reduce, prevent or treat pain and/or inflammation, wherein the drug depot (i) comprises one or more immediate release layer(s) that is capable of releasing about 5% to about 20% of the analgesic and the anti-inflammatory agent or pharmaceutically acceptable salts thereof relative to a total amount of the analgesic and the anti-inflammatory agent or pharmaceutically acceptable salts thereof loaded in the drug depot over a first period of up to 48 hours and (ii) one or more sustain release layer(s) that is capable of releasing about 21% to about 99% of the analgesic and the anti-inflammatory agent or pharmaceutically acceptable salts thereof relative to a total amount of the analgesic and/or the anti-inflammatory agent or pharmaceutically acceptable salts thereof
  • the target tissue site may comprise at least one muscle, ligament, tendon, cartilage, spinal disc, spinal foraminal space near the spinal nerve root, facet or spinal canal.
  • the target tissue may be associated with an acute disease or chronic disease or surgery.
  • an implantable drug depot comprising one or more immediate release layer(s) that releases a bolus dose of at least one analgesic agent or pharmaceutically acceptable salt thereof and at least one anti-inflammatory agent or pharmaceutically acceptable salt thereof at a site beneath the skin and (ii) one or more sustain release layer(s) that releases an effective amount of at least one analgesic agent or pharmaceutically acceptable salt thereof and at least one anti-inflammatory agent or pharmaceutically acceptable salt thereof over a period of 3 days to 6 months.
  • the one or more immediate release layer(s) may comprise poly (lactide-co-glycolide) (PLGA) and the one or more sustain release layer(s) may comprise polylactide (PLA).
  • the drug depot comprising the active ingredients can be made by combining a biocompatible polymer and a therapeutically effective amount of the active ingredients or pharmaceutically acceptable salts thereof and forming the implantable drug depot from the combination.
  • a solvent system is typically selected that contains one or more solvent species.
  • the solvent system is generally a good solvent for at least one component of interest, for example, biocompatible polymer and/or therapeutic agent.
  • the particular solvent species that make up the solvent system can also be selected based on other characteristics, including drying rate and surface tension.
  • Solution processing techniques include solvent casting techniques, spin coating techniques, web coating techniques, solvent spraying techniques, dipping techniques, techniques involving coating via mechanical suspension, including air suspension (e.g., fluidized coating), ink jet techniques and electrostatic techniques. Where appropriate, techniques such as those listed above can be repeated or combined to build up the depot to obtain the desired release rate and desired thickness.
  • a solution containing solvent and biocompatible polymer are combined and placed in a mold of the desired size and shape.
  • the solution can further comprise, one or more of the following: other therapeutic agent(s) and other optional additives such as radiographic agent(s), etc. in dissolved or dispersed form. This results in a polymeric matrix region containing these species after solvent removal.
  • a solution containing solvent with dissolved or dispersed therapeutic agent is applied to a pre-existing polymeric region, which can be formed using a variety of techniques including solution processing and thermoplastic processing techniques, whereupon the therapeutic agent is imbibed into the polymeric region.
  • Thermoplastic processing techniques for forming the depot or portions thereof include molding techniques (for example, injection molding, rotational molding, and so forth), extrusion techniques (for example, extrusion, co-extrusion, multi-layer extrusion, and so forth) and casting.
  • Thermoplastic processing in accordance with various embodiments comprises mixing or compounding, in one or more stages, the biocompatible polymer(s) and one or more of the following: the active ingredients, optional additional therapeutic agent(s), radiographic agent(s), and so forth.
  • the resulting mixture is then shaped into an implantable drug depot.
  • the mixing and shaping operations may be performed using any of the conventional devices known in the art for such purposes.
  • thermoplastic processing there exists the potential for the therapeutic agent(s) to degrade, for example, due to elevated temperatures and/or mechanical shear that are associated with such processing.
  • certain therapeutic agents may undergo substantial degradation under ordinary thermoplastic processing conditions.
  • processing is preferably performed under modified conditions, which prevent the substantial degradation of the therapeutic agent(s).
  • some degradation may be unavoidable during thermoplastic processing, degradation is generally limited to 10% or less.
  • processing conditions that may be controlled during processing to avoid substantial degradation of the therapeutic agent(s) are temperature, applied shear rate, applied shear stress, residence time of the mixture containing the therapeutic agent, and the technique by which the polymeric material and the therapeutic agent(s) are mixed.
  • Mixing or compounding biocompatible polymer with therapeutic agent(s) and any additional additives to form a substantially homogenous mixture thereof may be performed with any device known in the art and conventionally used for mixing polymeric materials with additives.
  • a polymer melt may be formed by heating the biocompatible polymer, which can be mixed with various additives (e.g., therapeutic agent(s), inactive ingredients, etc. ) to form a mixture.
  • additives e.g., therapeutic agent(s), inactive ingredients, etc.
  • a common way of doing so is to apply mechanical shear to a mixture of the biocompatible polymer(s) and additive(s).
  • Devices in which the biocompatible polymer(s) and additive(s) may be mixed in this fashion include devices such as single screw extruders, twin screw extruders, banbury mixers, high-speed mixers, ross kettles, and so forth.
  • biocompatible polymer(s) and various additives may be premixed prior to a final thermoplastic mixing and shaping process, if desired (e.g ., to prevent substantial degradation of the therapeutic agent among other reasons).
  • a biocompatible polymer is precompounded with a radiographic agent (e.g ., radio-opacifying agent) under conditions of temperature and mechanical shear that would result in substantial degradation of the therapeutic agent, if it were present.
  • a radiographic agent e.g ., radio-opacifying agent
  • This precompounded material is then mixed with therapeutic agent under conditions of lower temperature and mechanical shear, and the resulting mixture is shaped into the active ingredient containing drug depot.
  • the biocompatible polymer can be precompounded with the therapeutic agent under conditions of reduced temperature and mechanical shear. This precompounded material is then mixed with, for example, a radio-opacifying agent, also under conditions of reduced temperature and mechanical shear, and the resulting mixture is shaped into the drug depot.
  • the conditions used to achieve a mixture of the biocompatible polymer and therapeutic agent and other additives will depend on a number of factors including, for example, the specific biocompatible polymer(s) and additive(s) used, as well as the type of mixing device used.
  • a depot is formed comprising PLGA or PLA polymer, a radio-opacifying agent (e.g ., bismuth subcarbonate), and a therapeutic agent prone to degradation by heat and/or mechanical shear (e.g ., clonidine),
  • the PGLA or PLA can be premixed with the radio-opacifying agent at temperatures of about, for example, 150°C to 170°C.
  • the therapeutic agent is then combined with the premixed composition and subjected to further thermoplastic processing at conditions of temperature and mechanical shear that are substantially lower than is typical for PGLA or PLA compositions.
  • the therapeutic agent and premixed composition can be mixed/compounded using a twin screw extruder at substantially lower temperatures (e.g ., 100-105°C), and using substantially reduced volumetric output (e.g ., less than 30% of full capacity, which generally corresponds to a volumetric output of less than 200 cc/min).
  • this processing temperature is well below the melting points of certain active ingredients, such as an anti-inflammatory and analgesic because processing at or above these temperatures will result in substantial therapeutic agent degradation.
  • the processing temperature will be below the melting point of all bioactive compounds within the composition, including the therapeutic agent. After compounding, the resulting depot is shaped into the desired form, also under conditions of reduced temperature and shear.
  • biodegradable polymer(s) and one or more therapeutic agents are premixed using non-thermoplastic techniques.
  • the biocompatible polymer can be dissolved in a solvent system containing one or more solvent species.
  • Any desired agents for example, a radio-opacifying agent, a therapeutic agent, or both radio-opacifying agent and therapeutic agent
  • Solvent is then removed from the resulting solution/dispersion, forming a solid material.
  • the resulting solid material can then be granulated for further thermoplastic processing (for example, extrusion) if desired.
  • the therapeutic agent can be dissolved or dispersed in a solvent system, which is then applied to a pre-existing drug depot (the pre-existing drug depot can be formed using a variety of techniques including solution and thermoplastic processing techniques, and it can comprise a variety of additives including a radio-opacifying agent and/or viscosity enhancing agent), whereupon the therapeutic agent is imbibed on or in the drug depot.
  • the resulting solid material can then be granulated for further processing, if desired.
  • an extrusion processes may be used to form the drug depot comprising a biocompatible polymer(s), therapeutic agent(s) and radio-opacifying agent(s).
  • Coextrusion may also be employed, which is a shaping process that can be used to produce a drug depot comprising the same or different layers or regions (for example, a structure comprising one or more polymeric matrix layers or regions that have permeability to fluids to allow immediate and/or sustained drug release).
  • Multi-region depots can also be formed by other processing and shaping techniques such as co-injection or sequential injection molding technology.
  • the depot that may emerge from the thermoplastic processing is cooled.
  • cooling processes include air cooling and/or immersion in a cooling bath.
  • a water bath is used to cool the extruded depot.
  • the immersion time should be held to a minimum to avoid unnecessary loss of therapeutic agent into the bath.
  • immediate removal of water or moisture by use of ambient or warm air jets after exiting the bath will also prevent re-crystallization of the drug on the depot surface, thus controlling or minimizing a high drug dose "initial burst" or “bolus dose” upon implantation or insertion if this is release profile is not desired.
  • a sustained release region of the drug depot may, in various embodiments, be made by immediately removal of water or moisture.
  • the drug depot can be prepared by mixing or spraying the drug with the polymer and then molding the depot to the desired shape.
  • active ingredients are used and mixed or sprayed with the PLGA or PEG550 polymer, and the resulting depot may be formed by extrusion and dried.
  • the drug depot may also comprise combining a biocompatible polymer and a therapeutically effective amount of at least one analgesic agent or pharmaceutically acceptable salt thereof and at least one anti-inflammatory agent or pharmaceutically acceptable salt thereof and forming the implantable drug depot from the combination.

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Claims (13)

  1. Arzneimitteldepot, das an oder in der Nähe einer Zielgewebestelle unterhalb der Haut eines Patienten implantierbar ist, wobei das Arzneimitteldepot, das biologisch abbaubar ist, eine therapeutisch wirksame Menge eines Arzneimittels und mindestens eine Oberfläche, die zur Aufnahme von einem oder mehreren Verankerungselementen geeignet ist, umfasst, um eine Bewegung des Arzneimitteldepots an oder in der Nähe der Zielgewebestelle zu beschränken, und das Verankerungselement Folgendes umfasst:
    einen ersten Kanal 12, der an einem ersten Ende des Arzneimitteldepots angeordnet ist und zur Aufnahme eines biologisch abbaubaren Nahtmaterials 16 geeignet ist, und
    einen zweiten Kanal 22, der an einem zweiten Ende des Arzneimitteldepots angeordnet ist und zur Aufnahme desselben biologisch abbaubaren Nahtmaterials 16 geeignet ist, nachdem das Nahtmaterial mit der Zielgewebestelle im Kontakt ist, um das Depot an oder in der Nähe einer Zielgewebestelle zu verankern, wobei das biologisch abbaubare Nahtmaterial weiter Folgendes umfasst: einen ersten Bereich 18, der einen Knoten, Rand, ein Kügelchen, einen Grat, eine Lasche oder Klammer umfasst, der/das/die den einen oder die mehreren Kanäle umgibt und verhindert, dass das Nahtmaterial durch den Kanal 12 hindurchgeht, und einen zweiten Bereich 17, der einen Knoten, Rand, ein Kügelchen, einen Grat, eine Lasche oder Klammer umfasst, der/das/die beim Ziehen den zweiten Bereich des Nahtmaterials durch den einen oder die mehreren Kanäle zwingt, um eine Bewegung des Depots zu beschränken; wobei optional der erste Bereich des Nahtmaterials einen Knoten, Rand, ein Kügelchen, einen Grat, eine Lasche oder Klammer umfasst, der/das/die verhindert, dass das Nahtmaterial durch den Kanal 22 hindurchgeht, wobei mindestens ein Bereich des Arzneimitteldepots die therapeutisch wirksame Menge des Arzneimittels über eine Zeitdauer von mindestens einem Tag freisetzen kann.
  2. Arzneimitteldepot nach Anspruch 1, wobei die mindestens eine Oberfläche einen oder mehrere Kanäle, Löcher, Anschlüsse, Rillen, Schlitze, Schlaufen, Haken, Widerhaken, Stiften, Laschen und/oder Klammern umfasst, die zur Aufnahme des einen oder der mehreren Verankerungselemente geeignet sind.
  3. Arzneimitteldepot nach Anspruch 1, wobei das Arzneimitteldepot einen Körper aufweist und sich der/das/die eine oder die mehreren Kanäle, Löcher, Anschlüsse, Rillen, Schlitze, Schlaufen, Haken, Widerhaken, Stifte und/oder Klammern von dem Körper des Arzneimitteldepots erstrecken.
  4. Arzneimitteldepot nach Anspruch 1, wobei das Verankerungselement einen Kanal umfasst, der zur Aufnahme eines biologisch abbaubaren Nahtmaterials geeignet ist, nachdem das Nahtmaterial mit der Zielgewebestelle im Kontakt ist, um das Depot an oder in der Nähe einer Zielgewebestelle zu verankern, oder wobei das biologisch abbaubare Nahtmaterial weiter einen Bereich umfasst, der den einen oder die mehreren Kanäle umgibt und verhindert, dass das Nahtmaterial durch den einen oder die mehreren Kanäle hindurchgeht; wobei optional der Bereich des Nahtmaterials einen Knoten, Rand, ein Kügelchen oder eine Klammer umfasst, der/das/die verhindert, dass das Nahtmaterial durch den Kanal hindurchgeht.
  5. Arzneimitteldepot nach Anspruch 1, wobei die mindestens eine Oberfläche zur Aufnahme eines biologisch abbaubaren Nahtmaterials geeignet ist, das schneller als das Arzneimitteldepot abgebaut wird.
  6. Arzneimitteldepot nach Anspruch 1, wobei die mindestens eine Oberfläche einen oder mehrere Kanäle umfasst und das eine oder die mehreren Verankerungselemente einen Abschnitt des biologisch abbaubaren Nahtmaterials umfassen, das innerhalb des einen oder der mehreren Kanäle angeordnet ist, sodass das biologisch abbaubare Nahtmaterial in den einen oder die mehreren Kanäle vorgefädelt ist.
  7. Arzneimitteldepot nach Anspruch 1, wobei das Arzneimittel ein schmerzlinderndes und/oder entzündungshemmendes Mittel oder pharmazeutisch verträgliche Salze davon umfasst und das Arzneimitteldepot biologisch abbaubar und zur Freisetzung des Arzneimittels über eine Zeitdauer von mindestens 1 Tag zur Behandlung von postoperativem Schmerz geeignet ist.
  8. Arzneimitteldepot nach Anspruch 1, wobei die mindestens eine Oberfläche zur Aufnahme eines biologisch abbaubaren Nahtmaterials geeignet ist, das schneller als das Arzneimitteldepot abgebaut wird.
  9. Arzneimitteldepot nach Anspruch 1, wobei der eine oder die mehreren Kanäle und das eine oder die mehreren Verankerungselemente einen Abschnitt des biologisch abbaubaren Nahtmaterials umfassen, das innerhalb des einen oder der mehreren Kanäle angeordnet ist, sodass das biologisch abbaubare Nahtmaterial in den einen oder die mehreren Kanäle vorgefädelt ist, oder wobei das Arzneimittel ein schmerzlinderndes und/oder entzündungshemmendes Mittel oder pharmazeutisch verträgliche Salze davon umfasst und das Arzneimitteldepot biologisch abbaubar und zur Freisetzung des Arzneimittels über eine Zeitdauer von mindestens 1 Tag zur Behandlung von postoperativem Schmerz geeignet ist.
  10. Arzneimitteldepot nach Anspruch 1, wobei der Bereich des Knotens, Rands, Kügelchens, Grats oder der Klammer (17 und 18) eine Oberfläche aufweist, die größer als die Kanäle (12 und 22) ist.
  11. Arzneimitteldepot nach Anspruch 1, wobei das Arzneimitteldepot ein biologisch abbaubares Biopolymer umfasst, das aus Folgenden ausgewählt ist: Poly(alpha-Hydroxysäuren), Poly(Lactid-co-Glycolid) (PLGA oder PLG), Polylactid (PLA), Polyglycolid (PG), Polyethylenglycol(PEG)-Konjugaten von Poly(alpha-Hydroxysäuren), Polyorthoestern, Polyaspirinen, Polyphosphagenen, Kollagen, Stärke, vorgelierter Stärke, Hyaluronsäure, Chitosanen, Gelatine, Alginaten, Albumin, Fibrin, Vitamin-E-Analoga, wie zum Beispiel alpha-Tocopherylacetat, d-alpha-Tocopherylsuccinat, D,L-Lactid oder L-Lactid, Poly(Glycolid-,-Caprolacton), -Caprolacton, Dextranen, Vinylpyrrolidon, Polyvinylalkohol (PVA), PVA-g-PLGA, PEGT-PBT-Copolymer (polyaktiv), Methacrylaten, Poly(N-Isopropylacrylamid), PEO-PPO-PEO (Pluronics), PEO-PPO-PAA-Copolymeren, PLGA-PEO-PLGA, PEG-PLG, PLA-PLGA, Poloxamer 407, PEG-PLGA-PEG-Triblock-Copolymeren und/oder SAIB (Saccharoseacetatisobutyrat) oder Kombinationen davon.
  12. Arzneimitteldepot nach Anspruch 1, wobei das Arzneimitteldepot ein biologisch abbaubares Polymer umfasst, das Poly(Milchsäure-co-Glycolsäure) (PLA) oder Poly(orthoester) (POE) oder eine Kombination davon umfasst.
  13. Ein oder mehrere biologisch abbaubare Arzneimitteldepots für die Verwendung bei der Behandlung oder Prävention von postoperativem Schmerz oder postoperativer Entzündung bei einem Patienten, der eine derartige Behandlung benötigt, wobei die Verwendung das Vernähen des einen oder der mehreren biologisch abbaubaren Arzneimitteldepots, die eine therapeutisch wirksame Menge eines schmerzlindernden und/oder entzündungshemmenden Mittels oder pharmazeutisch verträglichen Salzes davon umfassen, an oder in der Nähe einer Zielgewebestelle unterhalb der Haut umfasst, wobei das Arzneimitteldepot biologisch abbaubar ist und mindestens eine Oberfläche, die zur Aufnahme von einem oder mehreren Nahtmaterialien geeignet ist, umfasst, um eine Bewegung des Arzneimitteldepots an oder in der Nähe der Zielgewebestelle zu beschränken, und das Verankerungselement Folgendes umfasst: einen ersten Kanal 12, der an einem ersten Ende des Arzneimitteldepots angeordnet ist und zur Aufnahme eines biologisch abbaubaren Nahtmaterials 16 geeignet ist, und einen zweiten Kanal 22, der an einem zweiten Ende des Arzneimitteldepots angeordnet ist und zur Aufnahme desselben biologisch abbaubaren Nahtmaterials 16 geeignet ist, nachdem das Nahtmaterial mit der Zielgewebestelle im Kontakt ist, um das Depot an oder in der Nähe einer Zielgewebestelle zu verankern, wobei das biologisch abbaubare Nahtmaterial weiter Folgendes umfasst: einen ersten Bereich 18, der einen Knoten, Rand, ein Kügelchen, einen Grat, eine Lasche oder Klammer umfasst, der/das/die den einen oder die mehreren Kanäle umgibt und verhindert, dass das Nahtmaterial durch den Kanal 12 hindurchgeht, und einen zweiten Bereich 17, der einen Knoten, Rand, ein Kügelchen, einen Grat, eine Lasche oder Klammer umfasst, der/das/die beim Ziehen den zweiten Bereich des Nahtmaterials durch den einen oder die mehreren Kanäle zwingt, um eine Bewegung des Depots zu beschränken; wobei optional der erste Bereich des Nahtmaterials einen Knoten, Rand, ein Kügelchen, einen Grat, eine Lasche oder Klammer umfasst, der/das/die verhindert, dass das Nahtmaterial durch den Kanal 22 hindurchgeht, und das Arzneimitteldepot das schmerzlindernde und/oder entzündungshemmende Mittel oder pharmazeutisch verträgliche Salz davon über eine Zeitdauer von mindestens 1 Tag freisetzen kann.
EP09800802.2A 2008-07-23 2009-07-14 Wirkstoffdepots mit einem oder mehreren verankerungselementen Not-in-force EP2195073B1 (de)

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